Trending clinical topic: alopecia

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The conflict at this year’s Oscars, along with new findings about treatment options and key associations, helped make alopecia the hottest clinical topic this week. At the Oscars, Chris Rock made a joke about Jada Pinkett Smith’s hair, which caused her husband, Will Smith, to storm the stage and slap Rock. Pinkett Smith suffers from alopecia areata, an immune disorder that causes hair loss and can lead to depression. The incident happened on the same weekend as the American Academy of Dermatology’s 2022 annual meeting, where key findings on alopecia were presented (see infographic below).

Brett King, MD, PhD, associate professor of dermatology at Yale University School of Medicine presented the research, which was also published in the New England Journal of Medicine. King called the results “extremely significant,” saying “we’re taking a big step toward the goal of FDA approval of an alopecia areata drug.”

All patients involved had severe alopecia areata, defined as a Severity of Alopecia Tool (SALT) score ≥ 50, meaning hair coverage of 50% or less. The score ranges from 0 (no hair loss) to 100 (complete hair loss). The primary endpoint was a SALT score ≤ 20 (80% scalp hair coverage). The researchers pooled data from two trials, BRAVE-AA1 and BRAVE-AA2, with a combined enrollment of 1200. At baseline, patients enrolled in the trial had an average SALT score of 85.5. After 52 weeks, 39% of patients who received 4 mg baricitinib had at least 80% scalp coverage. In this group, nearly 3 out of 4 patients (74.1%) had at least 90% scalp coverage or a SALT score ≤ 10.

None of the adverse events occurred in more than 10% of participants. The most common were headaches, acne, and increased muscle-related blood markers. In February 2022, the FDA granted priority review to baricitinib for the treatment of severe alopecia areata. “This is a fantastic achievement and a major breakthrough in alopecia areata, especially for patients with the most severe and refractory cases,” said Arash Mostaghimi, MD, MPH, director of hospital dermatology at Brigham and Women’s Hospital.

Another encouraging recent finding suggests that any link between alopecia areata and COVID-19 is likely weak at best. A review of the systemic literature published in JAAD International found that only nine of 402 articles selected from three databases met the inclusion criteria for the study. “This number alone highlights the very small number of published papers investigating this link,” said study author Rachel E. Christensen, a graduate student at Rutgers Robert Wood Johnson Medical School. Although COVID-19 has been linked to various dermatological conditions, a 2021 South Korean study of 7,958 case patients and 218,779 control patients found no link between infection and alopecia, even after covariates such that age, gender and income level have been taken into account. Overall, the results suggest that alopecia “may be a dermatological manifestation of COVID-19, with cases most often appearing 1 to 2 months after infection,” according to the authors. “However, the heterogeneity of study designs and the high proportion of case reports make it difficult to draw conclusions.”

Worldwide, the lifetime incidence of alopecia is approximately 2%. About 700,000 people in the United States have the condition, according to a 2020 study. Of those, just over half are women. The stigma associated with hair loss remains prevalent, which helps explain the emotional reaction of many to the Oscars incident and the significance of recent therapeutic discoveries. Pop culture and science have combined to result in this week’s hottest clinical topic.

Learn more about alopecia areata.

Jessica C. Bell